Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03455 | Date 21/11/2019 |
| Token No | SM/18-19/7621 21/11/2019 | Serial | 042 |
| Patient Name | Mr. AJAY KUMAR SHAW | Contact No | NOT GIVEN |
| Address | 9 NO LINE | Age | 58 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||